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Model Predictive Control (MPC) Artificial Pancreas vs. Sensor Augmented Pump (SAP)/Predictive Low Glucose Suspend (PLGS) With Different Food Choices in the Outpatient Setting

Primary Purpose

Type 1 Diabetes Mellitus

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
iAPS
Sponsored by
Sansum Diabetes Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes Mellitus focused on measuring Artificial Pancreas, Hyperglycemia, Hypoglycemia, Nutrition

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Clinical diagnosis, based on investigator assessment, of type 1 diabetes for at least one year and using insulin for at least 1 year.
  • Using an insulin pump for at least 3 months at the time of screening. Insulin pump use includes use of automated features, to include predictive or threshold low-glucose suspend or hybrid closed-loop with without a Dexcom sensor.
  • Familiarity and use of a carbohydrate ratio for meal boluses.
  • Age ≥18.0 years old
  • HbA1c < 10.5%, as performed by point of care or central laboratory testing. A1c will be assessed at the screening visit, or if already completed within 2 weeks of the screening visit, the prior lab value may be used in lieu of repeating this assessment.
  • For females, not currently known to be pregnant. If female and sexually active, must agree to use a form of contraception to prevent pregnancy while a participant in the study. A negative serum or urine pregnancy test will be required for all females of child-bearing potential. Participants who become pregnant will be discontinued from the study. Also, participants who during the study develop and express the intention to become pregnant within the timespan of the study will be discontinued.
  • Willingness to switch home pump to PLGS or full manual mode if using hybrid closed-loop with an FDA approved system.
  • Have an emergency contact living at home with the subject who will be available to be contacted by the study staff overnight in the event of an emergency.
  • Investigator has confidence that the participant can successfully operate all study devices and is capable of adhering to the protocol, to include having basic cooking equipment at home to prepare the study meals.
  • Willingness to switch to lispro (Humalog) or aspart (Novolog) if not using already, and to use no other insulin besides lispro (Humalog) or aspart (Novolog) during the study.
  • Willingness not to start any new non-insulin glucose-lowering agent during the course of the trial.

Exclusion Criteria:

  • Use of an unapproved closed-loop insulin delivery system within 2 weeks before screening or during the study is not allowed.
  • Gastrointestinal disease such as celiac disease or multiple food allergies.
  • Any form of gluten sensitivity or wheat allergy.
  • Allergies to any form of nuts or ingredients present in the study meals (tomatoes etc).
  • History of difficulty digesting food.
  • Concurrent use of Afrezza or any non-insulin glucose-lowering agent other than metformin (including GLP-1 agonists, Symlin, DPP-4 inhibitors, SGLT-2 inhibitors, sulfonylureas).
  • Hemophilia or any other bleeding disorder
  • One or more episodes of hypoglycemia requiring an emergency room visit or hospitalization in the past 6 months.
  • One or more episodes of hyperglycemia requiring an emergency room visit or hospitalization in the past 6 months.
  • Self-reported or clinically documented hypoglycemia unawareness.
  • A condition, which in the opinion of the investigator or designee, would put the participant or study at risk
  • Participation in another pharmaceutical or device trial at the time of enrollment or during the study
  • Having a direct supervisor at place of employment who is also directly involved in conducting the clinical trial (as a study investigator, coordinator, etc.); or having a first-degree relative who is directly involved in conducting the clinical trial

Sites / Locations

  • Sansum Diabetes Research Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Automated Insulin Delivery

SAP/PLGS

Arm Description

Participants will use the Automated Insulin Delivery (AID) iAPS system for 2 weeks in the outpatient setting. During AID use, subjects will consume 6 study meals (3 meals of each meal type in assigned random order, 1-2 portions per meal,) at dinner time over the 2-week period in a pre-assigned random order, and document on the study meal forms when they consume each numbered meal.

Participants will use their home pump with a CGM sensor (sensor augmented pump) or in Predictive Low Glucose Suspend (PLGS) mode if their home pump supports this mode, for 2 weeks in the outpatient setting. During these 2 weeks, subjects will consume 6 study meals (3 meals of each meal type in assigned random order, 1-2 portions per meal,) at dinner time over the 2-week period in a pre-assigned random order, and document on the study meal forms when they consume each numbered meal.

Outcomes

Primary Outcome Measures

Time in target glucose range
Time in target glucose range 70-180 mg/dL measured by CGM to determine safety and efficacy of the integrated system

Secondary Outcome Measures

Postprandial glucose peak
Postprandial glucose peak rise (highest measurement in mg/dL) from baseline glucose (mg/dl) for the 5-hour period after the study meals, during both use of SAP/PLGS and when using the iAPS
Time to postprandial glucose peak
Time (minutes) to postprandial glucose (highest measurement in mg/dL) rise from baseline glucose (mg/dl) during the 5-hour period after the study meals, during both use of SAP/PLGS and when using the iAPS
Postprandial Area Under the Curve
Area Under the Curve Glucose (mg/dl x min) for the 5-hour period after the study meals, during both use of SAP/PLGS and when using the iAPS
Postprandial time for glucose to return to baseline
Time (minutes) for CGM glucose to return to baseline (starting value) after the study meals, during both use of SAP/PLGS and when using the iAPS
Glucose < 70 mg/dL
Percent time GGM glucose < 70 mg/dL
Glucose < 54 mg/dL
Percent time GGM glucose < 54 mg/dL
Glucose > 180 mg/dL
Percent time GGM glucose > 180 mg/dL
Glucose > 250 mg/dL
Percent time GGM glucose > 250 mg/dL
Serious adverse events (SAE)
The total number of serious adverse events during the clinical trial
Serious adverse device events (SADE)
The total number of serious adverse events related to the study device use during the clinical trial
Adverse device effects (ADE)
The total number of adverse device effects (ADE) during the clinical trial
Unanticipated adverse device effects (UADE)
The total number of unanticipated adverse device effects (UADE) during the clinical trial

Full Information

First Posted
December 5, 2018
Last Updated
August 7, 2019
Sponsor
Sansum Diabetes Research Institute
Collaborators
Harvard University, Harvard School of Public Health (HSPH)
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1. Study Identification

Unique Protocol Identification Number
NCT03767790
Brief Title
Model Predictive Control (MPC) Artificial Pancreas vs. Sensor Augmented Pump (SAP)/Predictive Low Glucose Suspend (PLGS) With Different Food Choices in the Outpatient Setting
Official Title
A Randomized Crossover Comparison of Model Predictive Control (MPC) Artificial Pancreas vs. Sensor Augmented Pump (SAP)/Predictive Low Glucose Suspend (PLGS) With Different Food Choices in the Outpatient Setting
Study Type
Interventional

2. Study Status

Record Verification Date
August 2019
Overall Recruitment Status
Completed
Study Start Date
January 3, 2019 (Actual)
Primary Completion Date
June 27, 2019 (Actual)
Study Completion Date
June 27, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sansum Diabetes Research Institute
Collaborators
Harvard University, Harvard School of Public Health (HSPH)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
The objective of this randomized crossover clinical trial is to 1) assess the efficacy and safety of an automated insulin delivery (AID) system using a Model Predictive Control (MPC) algorithm versus sensor augmented pump therapy (SAP)/Predictive Low Glucose Suspend (PLGS) in people with type 1 diabetes, and 2) assess the impact of different meal macronutrient content on glucose control when using AID and SAP.
Detailed Description
The goal of this study is to compare the efficacy and safety of an AID system using a MPC algorithm versus SAP/PLGS therapy with different food choices over a 4 week period. The AID system (iAPS) is comprised of an insulin pump, a Dexcom G6 continuous glucose monitoring sensor, and a smart phone that contains the algorithm and communicates with the other devices. In this study, during each two-week period, subjects will be given pre-weighed portions of different meals to eat (either regular semolina pasta or extra-long grain white rice) with detailed cooking instructions, and will eat these meals on 6 different occasions for dinner. They will bolus as they normally do for these meals. This will allow us to observe the postprandial meal response when using sensor-augmented pump (SAP) or iAPS, showing the importance of nutrition choices with modern technological treatments in T1D.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes Mellitus
Keywords
Artificial Pancreas, Hyperglycemia, Hypoglycemia, Nutrition

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
10 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Automated Insulin Delivery
Arm Type
Experimental
Arm Description
Participants will use the Automated Insulin Delivery (AID) iAPS system for 2 weeks in the outpatient setting. During AID use, subjects will consume 6 study meals (3 meals of each meal type in assigned random order, 1-2 portions per meal,) at dinner time over the 2-week period in a pre-assigned random order, and document on the study meal forms when they consume each numbered meal.
Arm Title
SAP/PLGS
Arm Type
No Intervention
Arm Description
Participants will use their home pump with a CGM sensor (sensor augmented pump) or in Predictive Low Glucose Suspend (PLGS) mode if their home pump supports this mode, for 2 weeks in the outpatient setting. During these 2 weeks, subjects will consume 6 study meals (3 meals of each meal type in assigned random order, 1-2 portions per meal,) at dinner time over the 2-week period in a pre-assigned random order, and document on the study meal forms when they consume each numbered meal.
Intervention Type
Device
Intervention Name(s)
iAPS
Intervention Description
The AID system (iAPS) is comprised of an insulin pump, a Dexcom G6 continuous glucose monitoring sensor, and a smart phone that contains the algorithm and communicates with the other devices.
Primary Outcome Measure Information:
Title
Time in target glucose range
Description
Time in target glucose range 70-180 mg/dL measured by CGM to determine safety and efficacy of the integrated system
Time Frame
4 weeks
Secondary Outcome Measure Information:
Title
Postprandial glucose peak
Description
Postprandial glucose peak rise (highest measurement in mg/dL) from baseline glucose (mg/dl) for the 5-hour period after the study meals, during both use of SAP/PLGS and when using the iAPS
Time Frame
4 weeks
Title
Time to postprandial glucose peak
Description
Time (minutes) to postprandial glucose (highest measurement in mg/dL) rise from baseline glucose (mg/dl) during the 5-hour period after the study meals, during both use of SAP/PLGS and when using the iAPS
Time Frame
4 weeks
Title
Postprandial Area Under the Curve
Description
Area Under the Curve Glucose (mg/dl x min) for the 5-hour period after the study meals, during both use of SAP/PLGS and when using the iAPS
Time Frame
4 weeks
Title
Postprandial time for glucose to return to baseline
Description
Time (minutes) for CGM glucose to return to baseline (starting value) after the study meals, during both use of SAP/PLGS and when using the iAPS
Time Frame
4 weeks
Title
Glucose < 70 mg/dL
Description
Percent time GGM glucose < 70 mg/dL
Time Frame
4 weeks
Title
Glucose < 54 mg/dL
Description
Percent time GGM glucose < 54 mg/dL
Time Frame
4 weeks
Title
Glucose > 180 mg/dL
Description
Percent time GGM glucose > 180 mg/dL
Time Frame
4 weeks
Title
Glucose > 250 mg/dL
Description
Percent time GGM glucose > 250 mg/dL
Time Frame
4 weeks
Title
Serious adverse events (SAE)
Description
The total number of serious adverse events during the clinical trial
Time Frame
4 weeks
Title
Serious adverse device events (SADE)
Description
The total number of serious adverse events related to the study device use during the clinical trial
Time Frame
4 weeks
Title
Adverse device effects (ADE)
Description
The total number of adverse device effects (ADE) during the clinical trial
Time Frame
4 weeks
Title
Unanticipated adverse device effects (UADE)
Description
The total number of unanticipated adverse device effects (UADE) during the clinical trial
Time Frame
4 weeks
Other Pre-specified Outcome Measures:
Title
Total daily insulin use
Description
Total daily insulin use (units/day) during both use of SAP/PLGS and when using the iAPS
Time Frame
4 weeks
Title
Total basal insulin use
Description
Total daily basal insulin use (units/day) during both use of SAP/PLGS and when using the iAPS
Time Frame
4 weeks
Title
Total bolus insulin use
Description
Total daily bolus insulin use (units/day) during both use of SAP/PLGS and when using the iAPS
Time Frame
4 weeks
Title
Sensor Use Time
Description
Total hours of CGM sensor use time during both use of SAP/PLGS and when using the iAPS
Time Frame
4 weeks
Title
Closed-Loop Active Time
Description
Percent time (hours/day) of closed-loop use during the two weeks of iAPS use
Time Frame
2 weeks
Title
Device Issues
Description
Total number of devices issues during the clinical trial
Time Frame
4 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Clinical diagnosis, based on investigator assessment, of type 1 diabetes for at least one year and using insulin for at least 1 year. Using an insulin pump for at least 3 months at the time of screening. Insulin pump use includes use of automated features, to include predictive or threshold low-glucose suspend or hybrid closed-loop with without a Dexcom sensor. Familiarity and use of a carbohydrate ratio for meal boluses. Age ≥18.0 years old HbA1c < 10.5%, as performed by point of care or central laboratory testing. A1c will be assessed at the screening visit, or if already completed within 2 weeks of the screening visit, the prior lab value may be used in lieu of repeating this assessment. For females, not currently known to be pregnant. If female and sexually active, must agree to use a form of contraception to prevent pregnancy while a participant in the study. A negative serum or urine pregnancy test will be required for all females of child-bearing potential. Participants who become pregnant will be discontinued from the study. Also, participants who during the study develop and express the intention to become pregnant within the timespan of the study will be discontinued. Willingness to switch home pump to PLGS or full manual mode if using hybrid closed-loop with an FDA approved system. Have an emergency contact living at home with the subject who will be available to be contacted by the study staff overnight in the event of an emergency. Investigator has confidence that the participant can successfully operate all study devices and is capable of adhering to the protocol, to include having basic cooking equipment at home to prepare the study meals. Willingness to switch to lispro (Humalog) or aspart (Novolog) if not using already, and to use no other insulin besides lispro (Humalog) or aspart (Novolog) during the study. Willingness not to start any new non-insulin glucose-lowering agent during the course of the trial. Exclusion Criteria: Use of an unapproved closed-loop insulin delivery system within 2 weeks before screening or during the study is not allowed. Gastrointestinal disease such as celiac disease or multiple food allergies. Any form of gluten sensitivity or wheat allergy. Allergies to any form of nuts or ingredients present in the study meals (tomatoes etc). History of difficulty digesting food. Concurrent use of Afrezza or any non-insulin glucose-lowering agent other than metformin (including GLP-1 agonists, Symlin, DPP-4 inhibitors, SGLT-2 inhibitors, sulfonylureas). Hemophilia or any other bleeding disorder One or more episodes of hypoglycemia requiring an emergency room visit or hospitalization in the past 6 months. One or more episodes of hyperglycemia requiring an emergency room visit or hospitalization in the past 6 months. Self-reported or clinically documented hypoglycemia unawareness. A condition, which in the opinion of the investigator or designee, would put the participant or study at risk Participation in another pharmaceutical or device trial at the time of enrollment or during the study Having a direct supervisor at place of employment who is also directly involved in conducting the clinical trial (as a study investigator, coordinator, etc.); or having a first-degree relative who is directly involved in conducting the clinical trial
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Eyal Dassau, PhD
Organizational Affiliation
John A. Paulson School of Engineering and Applied Sciences
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
David Eisenberg, MD
Organizational Affiliation
Harvard School of Public Health (HSPH)
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Jordan E Pinsker, MD
Organizational Affiliation
Sansum Diabetes Research Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sansum Diabetes Research Institute
City
Santa Barbara
State/Province
California
ZIP/Postal Code
93105
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
32319791
Citation
Deshpande S, Pinsker JE, Church MM, Piper M, Andre C, Massa J, Doyle Iii FJ, Eisenberg DM, Dassau E. Randomized Crossover Comparison of Automated Insulin Delivery Versus Conventional Therapy Using an Unlocked Smartphone with Scheduled Pasta and Rice Meal Challenges in the Outpatient Setting. Diabetes Technol Ther. 2020 Dec;22(12):865-874. doi: 10.1089/dia.2020.0022. Epub 2020 Oct 13.
Results Reference
derived

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Model Predictive Control (MPC) Artificial Pancreas vs. Sensor Augmented Pump (SAP)/Predictive Low Glucose Suspend (PLGS) With Different Food Choices in the Outpatient Setting

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